Valere Aude: Dare to Be Healthy, Or, The Light of Physical Regeneration

by Louis Dechmann

SMALL-POX.

As a matter of fact Chicken-pox is of congeneric origin with small-pox, with which, in a very much milder degree, it has various features in common. But small-pox itself is engendered of foul and insanitary conditions of life, impure blood and bad and insufficient nourishment and these, together with its risk under unscientific conditions and in times past of facial disfigurement, have made its name more repugnant to the layman than perhaps any other form of disease. All that need be said about it here, however, is that it is largely a terror of the past and that the sure preventative against it always, and the one reliable anti-toxin against contagion, under all circumstances, is good healthy blood and hygienic-dietetic living.

Those readers who may desire a minute description of this form of disease will find the same in chapt: XII of my greater work "Regeneration."

TYPHOID FEVER OR TYPHUS ABDOMINALIS.

(A) General Description.

This description of fever is usually termed typhus or nerve fever. It characterizes all forms of typhoid disease of which the following features constitute the prominent symptoms.

To a peculiar degree, chiefly young and strong individuals of from 15 to 30 years of age are attacked by this disease, while those in early youth and of more advanced years are much less subject to the same.

It is a complaint very dangerous to those who eat and drink to excess and without discretion. Strong excitement of the mind, such as a shock or great anguish, will undoubtedly favor the appearance of typhus. The seasons too have considerable influence upon it, most cases occurring during the Autumn months—from August to November.

It has been previously indicated to what extent the study of the hygienic conditions of life will assist in the discovery of the real causes of so-called contagious disease. One instance may show the enormous influence of dietetic movements on the outbreak of great epidemics.

It is reported in the "Journal of the Sanitary Institute," London, that the English Seaside Resort Brighton, in the period from July, 1893, to August, 1896, 238 cases of abdominal typhus were observed,—about equally divided for the different years. In 56 cases the typhus was caused by the eating of oysters (36 cases) or clams (20 cases). There was evidence that the water from which these oysters and clams were taken was badly polluted by the excrement of several thousand people, brought through sewers to the place were the shell-fish had been gathered. It was very characteristic in a number of cases that only one of a number of persons, who were otherwise living under equal conditions, fell ill with typhus, a short while after having eaten some of the shell-fish. No other points essential to the spreading of this contagious disease could be discovered. Brighton is healthily situated and built; hygienic conditions in general are favourable; much attention is paid particularly to keeping the soil clean, removing all faeces and providing good drinking water. Contamination through milk in all of the 56 cases, according to most careful investigations, was out of the question. They occurred in entirely different streets in various precincts of the town; 45 of the patients lived on 43 different streets. Besides the people attacked by typhus, many other persons fell ill from lighter disease of the intestines, after having eaten of these crustaceous bivalves, the symptoms being diarrhoea and pains in the stomach. Measures were taken to remove the noxious causes as soon as the source of infection was discovered.

The same conditions were some time ago noticed in Berlin. Out of 14 people invited to a dinner, nine fell ill—5 of them very seriously—under symptoms of typhus, after having eaten oysters from Heligoland. Part of the personnel of the kitchen and some of the servants were taken ill with the same critical symptoms.

B. Essentials.

Abdominal typhus is a general illness of the whole body, and consequently all organs of the body are more or less altered in a morbid way while the disease lasts. The main change occurs in the lymphatic glands of the intestines and in the spleen.

The following are its anatomical symptoms: With the beginning of the disease the lymphatic glands of the mucous membrane of the intestines begin to swell; they are constantly growing during the course of the disease and attain the size of a pea; extended over the level of the mucous membrane they feel firm, hard and tough. In favourable cases the swelling may go down at this stage, but generally the formation of matter begins through the dying of the cells, caused by insufficient nourishment. This is gradually thrown off, and a loss of substance remains—the typhoid ulcer. This varies in size and in depth. Light bleeding in no great quantity ensues. If the ulcer has gone very deep, the intestines may be perforated and then the faeces and part of the food enter the abdominal cavity. The result is purulent and ichorous peritonitis. As a rule, however, the ulcers are purified and heal by cicatrization. Usually the spleen is enormously enlarged (through a rapid increase in the number of its cells). The swelling of the spleen can easily be detected by external touch.

(C) Symptoms and Course.

During what is termed the earlier stage, which as a rule last about two weeks and precedes the breaking out of the disease proper, the patient still feels comparatively well, or only begins to complain of headache, tired feeling, prostration in all the limbs, dizziness, lack of appetite. It is thus absolutely impossible to fix a definite date for its development. In most cases the patient complains of a chill, followed by feverishness,—symptoms which confine him to bed,—although no actual shivering takes place. It is expedient, although quite arbitrary and subject to many modifications, to divide the course of the illness into three periods:—

(1) The stage of development.

(2) The climax.

(3) The stage of healing.

During the stage of development, which usually lasts about a week, the symptoms of the disease rapidly increase. The patient gets extremely weak and faint, has severe headaches and absolutely no appetite. In consequence of the high fever, he complains of thirst; the skin is dry, the lips chapped, the tongue coated; the pulse is rapid and full; the bowels are constipated, but the abdomen is practically not inflated nor sensitive to pressure. In most cases the spleen is evidently enlarged.

Before the end of the first week the climax is reached. This in the lighter cases lasts for the second week, or in more severe cases, even until the third. The fever is constantly high, even 104° and over. The body is generally benumbed, the patient becomes delirious at night or lies absolutely indifferent to all surroundings. The abdomen is now inflated, the buttocks show small, light red spots,—the so-called "roseola,"—which are characteristic of abdominal typhus. Furthermore, in most cases, bronchial catarrh of a more or less severe nature appears. Instead of obstruction of the bowels there is diarrhoea—about two to six light yellow thin stools, occur within 24 hours. During this second stage the complications appear.

At the end of the second or the third week respectively, the fever slackens; in cases which take a favourable turn, the patient becomes less benumbed and less indifferent, his sleep is quieter; appetite gradually returns. The bronchial catarrh grows better, the stool once more becomes normal; in short, the patient enters the stage of convalescence.

This is a short sketch of the course the illness usually takes.

Of the deviations and complaints accompanying Abdominal Typhus, the following are the most important details:—

The fever takes its course in strict accordance with the described anatomical changes in the intestines. It increases gradually during the first week, and at the end of that period it reaches its maximum of about 104°. It stays at that point during the second stage, gradually sinking during the third stage.

In lighter cases the second stage may be extraordinarily short.

If perforation of the intestines, heavier bleeding or general collapse should ensue, attention is directed thereto through sudden and considerable decrease in the temperature of the body. Pneumonia, inflammation of the inner ear and other accompanying complications also cause sudden access of fever.

Effect upon the digestive organs: The tongue is generally coated while the fever lasts; the lips are dry and chapped, and look brown from bleeding. If the patient is not carefully attended to during the extreme numbness, a fungus growth appears which forms a white coating over the tongue, the cavity of the mouth and the pharynx, and may extend into the oesophagus. Later on the tongue loses this coating and becomes red as before. Few symptoms are shown by the stomach, except occasional vomiting and lack of appetite. During convalescence there is great desire for food. The anatomical changes in the intestines have already been mentioned.

While obstruction prevails during the first week, the second week is characterized by diarrhoea of a pale and thin consistency.

When general improvement sets in, the stools gradually decrease in number, they grow more solid and finally reach the normal. The abdomen is not very sensitive to pressure and is usually intensely inflated with gas.

In the region of the right groin a cooing sound is often heard, caused by a liquid substance in the intestines, which can be felt under pressure of the finger.

Bleeding from the intestines is not infrequent and happens during the third week of the illness. It usually indicates a bad complication, since the result may be fatal. The stool assumes a tar-like appearance through the mixture of the coagulated blood with the faeces. Close attention must be given to minor hemorrhages, since they often herald others of a more intense nature.

In such extreme cases of serious complications, however, a cure has nevertheless been sometimes effected. They are occasionally followed by the immediate beginning of convalescence.

The perforation of the intestines, which is caused by an ulcer eating its way through the wall of the intestines, is much more dangerous. It happens most frequently during the third or the fourth week. The patient feels a sudden, most intense pain in the abdomen; he collapses rapidly, the cheeks become hollow, the nose pointed and cool. Vomiting follows, the pulse becomes weak and extremely rapid. The abdomen is enormously inflated and painful. In the severest cases death ensues, at latest, within two or three days, the cause being purulent and ichorous (or pus-laden) peritonitis.

Such extreme developments as these, however, are infrequent, since the illness, by timely attention according to the methods herein prescribed, will, as a rule, respond to the treatment and take a favourable turn.

Respiratory Organs:—

In the course of typhus, intense bleeding of the nose is not infrequent. In the severer cases this is a sign of decomposition of the blood, but in lighter cases it merely serves to alleviate the intense headache which is a feature of the case. The throat is liable to be affected; hoarseness and coughing occur; hardly any case of typhus catarrh. This sometimes extends into the air-passes without a more or less intense bronchial cells and causes catarrhal pneumonia, which—if not promptly treated according to the instructions herein detailed—may become extremely dangerous.

Organs of Circulations:—

With the exception of a strongly accelerated action, no change is noticeable in the heart. It may, however, suddenly become paralyzed and cease entirely, owing to the general weakness of the patient and the intensity of the fever. Weakness of the heart and possible cessation occur only during the climax or convalescence.

Nervous System:—

Disturbances of the nervous system are very frequent, hence the name "nervous fever."

Consciousness is, in nearly all cases, more or less benumbed, and at times completely lost. The patient is either lying absolutely indifferent, or he is delirious, cries, rages, attempts to jump out of bed and can only be subdued by the strongest efforts.

Patients lose control of urinary and faecal movements and require feeding.

These disturbances disappear as soon as convalescence sets in and consciousness returns.

As a rule the patient, on return to consciousness, knows nothing of what he has gone through, and has no reminiscences of the immediate past.

Sometimes cramps in the masticatory muscles have been observed, which explains the grinding of teeth apparent in some instances. Convulsions in the limbs and facial muscles sometimes appear, but most of these disturbances are of short duration.

Urinary and Sexual Organs:—

With high fever albumen appears in the urine. In some instances it may lead to inflammation of the kidneys, the symptoms of which may at times completely overshadow the symptoms of typhus. Fortunately this complication is very rare. Catarrh of the bladder occurs, because the patient retains the urine too long, while in a state of unconsciousness. Inflammation of the testicles has been observed with male patients, and pregnant women have miscarried or given birth prematurely.

Bones and Joints:—

Inflammation of the joints is infrequent and in a few cases only, inflammation of the periosteum has been observed.

Skin:—

At the beginning of the second week small rose-like spots of a light rose colour appear on the buttocks (roseola typhosa), which later on are also found on the upper legs, upper arms and back. They soon disappear, however, and leave no traces.

Pustular eczema is so rare in cases of typhus, that as a rule its appearance is taken to indicate that the disease is not a case of abdominal typhus. Frequently, however, urticaria, (nettle-rash) perspiration and other pustules are to be noticed.

The great variety of symptoms indicates that innumerable peculiarities may occur in the course of typhus. In some cases it is so light and indistinct (walking typhoid) that it is extremely difficult to diagnose it. In other cases pneumonia or unconsciousness, headache or stiff neck are indicated so overwhelmingly, that it is well-nigh impossible to recognize the underlying illness as typhus. In such cases one speaks of lung and brain typhus.

Recurrence:—

In about 10% of all cases recurrence is observed, mostly caused through mistakes in diet, leaving bed too soon, and excitement. Usually in such relapses the fever takes the same course as the original attack, but is much less intense. Although such secondary attacks are not very dangerous as a rule, great caution should be observed, especially in regard to diet, which must be followed in the strictest way until all danger has passed.

Complications and Subsequent Troubles:—are very frequent and a serious menace to life.

The most important are hemorrhage of the brain, meningitis, erysipelas, gangrene of the skin and bones, wasting of the muscles, fibrinous pneumonia; pericarditis, and frequently weakness of the heart with its consequences.

Purulent inflammation of the middle ear is one which deserves special attention.

Loss of hair is a frequent occurrence during convalescence, owing to the ill-nourished condition of the skin; this, however, is but a temporary feature soon succeeded by renewed growth.

The prognosis or forecast of typhus is not altogether bad, notwithstanding the gravity of its symptoms and the dangers of its course.

Statistics show that the mortality from typhus does not exceed 7% but each complication makes the result more uncertain and the outlook less hopeful. In the event of perforation of the intestines and severe internal hemorrhage supervening, the chances of saving life are slender.

D. Treatment.

The treatment of typhus requires, in the first place, a correct judgment of the physical condition of the patient in determining the fever treatment to be applied. Success in severe cases of typhus will only be secured by those who understand the correct methods of treating the skin. Robust patients, with reserve energy and resisting power, may receive the unrelaxing application of repeated whole packs or cool full baths. There is, however, a species of endurance, which may prove unable to endure the sustained and active force of these applications. In such cases milder applications and more frequent changes are recommended. Packs, interchanged with baths, clysters or enemas which subdue fever, alternated with ablutions, and similar methods.

Extremely stout and nervous patients must be treated with the greatest caution.

As typhus cases gradually develop, care must be exercised to prevent too violent treatment in case of serious complications. In fact the physician must not be guided by fixed rules, but must be able to individualize with prompt discretion.

During the severest stage the diet must be absolutely a fever diet, prescribed in Form II, while patients suffering from lighter attacks, and convalescents, may be permitted the milder fever diet, given in Form III.

Mental Condition. Great care and observation is necessary with regard to the patient's mental state. The observance of a quiet demeanour on the part of everyone about the sick room should help to keep the patient quiet and undisturbed and may serve to preserve his consciousness.

I have treated very severe cases of typhus, with extremely high fever, during which, however, consciousness remained. Inexorable strictness in this respect is often resented and misunderstood by those surrounding the patient until they realize the far-reaching importance of the orders by comparison with other cases.

Cold ablutions on the affected parts, air and water cushions, must be employed early enough to avert any danger of bed-sores.

This strict treatment of the patient—physically and mentally, will in most cases be sufficient to render his condition endurable; otherwise the struggle against the irritation of complications becomes intense, rendering it imperative, in the first degree, that the brain symptoms should be carefully watched.

Cold compresses on the head must be used in case such symptoms appear, but absolute undisturbed rest will conduce more than anything else to their infrequent occurrence.

Collapse must be contended against with light stimulating food (light bouillon of veal or chicken with a little condensed substance). Wine with alcohol might endanger the life of the patient. If the collapse is protracted, constituting a menace to life, the addition of cold water to the lukewarm bath and similar procedure may be tried, but only by a skilled expert.

Diarrhoea must be resisted by means of diet and clysters (enemas) with rice-water, if necessary; the enemas must be given cautiously. They are dangerous on account of possible violations and consequently rupture of the ulcerated intestines. These and other points, however, such as threatening paralysis etc., are entirely in the hands of the physician.

The contest against all the complications of typhus must be directed by absolutely skilled and experienced persons only, since in this disease particularly every mistake of any importance whatsoever, may cost the life of the patient.

Besides this specific form of typhus which commands general attention, the others are of merely theoretical interest. One, however, I wish to mention in passing; namely:

E. Relapsing Fever (Typhus Recurrens).

This also begins with chills and shivering, and a general tired feeling, and is immediately followed by high fever, up to a temperature of 104°. The skin is covered with excretory perspiration. The brain symptoms are lacking. The illness reaches its climax very quickly; but suddenly the patient feels much better, after extremely free perspiration. He continues remarkably well for about a week, when a new attack of the illness, a relapse, occurs. There are frequently from three to four relapses of this kind, which severely tax the strength of the patient.

The number and the intensity of these relapses determines the degree of the illness.

The treatment is regulated in accordance with the principles to be applied in abdominal typhus. The relapses may be averted or at any rate reduced to a great degree, by strict observance of the methods herein prescribed, especially in regard to diet.

F. Diet in Cases of Typhus.

Typhus abdominalis is a form of disease which requires the most careful dietetic treatment, since it combines high fever, which lasts for several weeks, with a severe ulcerous process in the small and large intestines.

Nutrition is seriously hampered by the long duration of the illness, usually considerable lack of appetite and the absolute necessity of nursing the ulcerous intestines in the most studiously careful way.

In cases which develop to the highest degree, it naturally follows that the patient wastes away to a great extent.

In the first place, all solid food must be strictly avoided. Too great stress cannot be laid on this point, since the patient, especially in lighter cases, frequently shows a strong desire for food—especially fruit.

Any lack of firmness and caution in this respect may have the most disastrous consequences. Many a patient suffering from typhus has lost his life or experienced a bad relapse and hemorrhages of the intestines through a mistake in diet,—through taking too much or unsuitable food.

The most critical period for the liability to hemorrhage, which in some cases is very profuse, is the third, and in lighter cases, the second week, when the crust of the intestinal ulcers begins to scale off.

The diet list, as in cases of typhus, consists of Form II, and milk; and it should be made a rule to confine it strictly to the most simple food, bouillon, mucilaginous soups, milk, undiluted or with tea, everything prepared with a little egg. Cream will sometimes agree with the patient.

The stools will indicate the digestion or otherwise of the milk. If there are many morsels of casein apparent in the same, the quantity of milk must be reduced and given in diluted form. The use of meat juice, liquid or frozen, and meat jelly, is quite permissible. Although neither of these preparations are very strong, they must be considered as important building-stones for the nourishment of the patient, and they offer a little variety, which is often most desirable.

Drinks. For drinking, usually fresh water is used, also bread and albumen water, especially Dechmann's Plasmogen, 15 grains in one pint of water, a mouthful from time to time alternating with Dechmann's Tonogen.

Great caution must be used in regard to fruit juices and lemonade on account of the danger of irritation of the intestines.

Carbonated and other mineral waters must be strictly avoided, since they only add to the usually prevailing meteorism, or gas in the abdominal cavity.

Albumen water, which is occasionally used in case of febrile disease and intestinal catarrh of children, is prepared by mixing the white of an egg and two to four spoonfuls of sugar in a tumbler of water. This is strained and cooled before being used. It is easily understood that by this we generate new life in the patient, so to speak, through the albumen, since it contains a large quantity of tissue building material, which in turn prevents catabolism or destruction of the organism, this as contrasted with the methods of the old regime which dooms the patient to certain death by opiates,—a course frequently resorted to by inexperienced practitioners.

If, by attention and care, the treatment has succeeded in strengthening the energy of the resisting organism to a certain degree during the fever, it becomes necessary in due course to regulate the desire for food, which sometimes grows and asserts itself in a rapid and energetic manner, while the fever is receding.

The cessation of fever by no means indicates that the ulcers are completely healed, and any mistake as to quantity and quality of food may cause a relapse. Liquid diet must, therefore, be given exclusively for at least, another eight days after the fever has ceased. After this, from week to week, gradually, the use of Form III, may be employed and thereafter more solid food, as given anon, under Form IV.

These cautions must be strictly heeded, especially in case of typhus recurrens.

If in the course of typhus severe complications, such as hemorrhage of the intestines or perforation thereof, should supervene, nourishment must immediately be reduced to a minimum. In such instances it is best to confine the diet to mucilaginous soup and to forbid everything else, as long as hemorrhages have not ceased, or the other dangerous peritonitic symptoms have not disappeared. Gradually, Form V and lastly, Form VI, may be followed.

Form IV. Diet of the lightest kind, containing meat, but only in scraped or shredded form. Noodle soup, rice soup.

Mashed boiled brains or sweetbread, or puree of white or red roasted meat, in soup.

Brains and sweetbread boiled.

Raw scraped meat (beef, ham, etc.)

Lean veal sausages, boiled.

Mashed potatoes prepared with milk.

Rice with bouillon or with milk.

Toasted rolls and toast.

Form V. Light diet, containing meat in more solid form.

Pigeon, chicken boiled.

Small fish, with little oil, such as brook or lake trout, boiled.

Scraped beefsteak, raw ham, boiled tongue.

As delicacies: small quantities of caviar, frogs' legs, oysters, sardelle softened in milk.

Potatoes mashed and salted, spinach, young peas mashed, cauliflower, asparagues tips, mashed chestnuts, mashed turnips, fruit sauces.

Groat or sago puddings.

Rolls, white bread.

Form VI. Somewhat heavier meat diet. (Gradually returning to ordinary food.)

Pigeon, chicken, young deer-meat, hare, everything roasted.

Beef tenderloin, tender roast beef, roast veal.

Boiled pike or carp.

Young turnips.

All dishes to be prepared with very little fat, butter to be used exclusively. All strong spices to be avoided. Regarding drinks to be taken with these forms of diet, as a rule good drinking water takes the first place. This is allowed under all circumstances. Still less irritating are weak decoctions of cereals, such as barley and rice water. Other light nutritive non-irritating drinks are bread water and albumen water.

Only natural waters, such as Vichy, Apollinaris with half milk or the like are to be used. Drinks containing fruit acid, like lemonade and fruit juices, are somewhat stimulating; however, in a general way, they may be given during fever, but not in typhus.

Of alcoholic drinks the best is light wine (bordeaux), first diluted and later in its natural state. As a rule it should not be used before Form IV has been followed and Form V commenced. Occasionally, mild white wine or well fermented beer, may be permitted. Coffee is absolutely forbidden during any of the foregoing forms of diet, but light teas with milk are allowed in most cases.

The main point in the different forms of diet as enumerated herein is to be found in the mechanical gradation of the substances in accordance with the progressive condition of the patient.

The diet in a certain individual case of the kind will not, however, always be necessarily identical with one or any of the foregoing forms, but must depend upon the individual condition.

In the first place, under each form there are easily discernible gradations, according to relative points of view which are all familiar to the physician and to which attention must be paid under similar circumstances. On the other hand, very often one of the items of a later form may be allowed while, in general, one of the previous forms is applied. Thus the transition from Form II to the first items of Form III is hardly perceptible.

Of course every form comprises all previous ones, so that each consecutive form affords a greater range than the last.

Occasionally other points than those I have mentioned may have to be taken into consideration. It is obviously impossible as the reader will observe, to formulate an absolutely uniform scheme applicable to every case.

Next to the description and quality of food, the quantity to be introduced into the stomach at one time, is a matter of the utmost vital importance.

DECH-MANNA-COMPOSITIONS.

(Only main compositions, specialities to Doctor's order.)

In all forms of Typhoid fever: Neurogen, Plasmogen, Tonogen, Eubiogen.

Physical: Partial Packs.